Position Summary:

The System Manager of Clinical Documentation Improvement (CDI) is responsible for assisting with planning, directing, organizing, monitoring, and staffing departmental services subject to policies, budgets, objectives and directives mandated by regulatory agencies, DNV, and the executive team. Supports revenue and quality data for the health system, through direction and coordination of all CDI functions and maintaining team discipline for all elements of established standard processes (work management, tools, team briefings, metrics tracking, and prompt resolution of issues, problems, and opportunities). Researches, develops, and facilitates education for CDIS and coding teams, as well as clinical partners, in alignment with clinical and coding guidelines. Works closely and collaboratively with all revenue cycle functions, interfacing with PFS, IT, compliance, finance, and physician leaders. This role is critical to the accurate development of claims and reportable quality metrics, using a current working knowledge of organizational structure, coding principles, governmental regulations, protocols, and third party requirements regarding coding and clinical documentation practices to ensure ethical, accurate, and complete coding, preventing and mitigating denials.

The System Manager of Clinical Documentation Improvement (CDI) is also responsible for providing medical staff leadership to the CDI program, as a Physician Advisor (PA). The Physician Advisor role leads and promotes processes for patients to receive medically necessary and high-quality care throughout the continuum of care, promoting medical care that reflects professional best practices and community standards of care. The PA assists in reducing the financial risks associated with denials that are due to providing medically unnecessary or preventable services and extended length of stays, and will have an indirect reporting relationship to the Chief Medical Officer (CMO).

Minimum Qualifications:

• Associate’s or Bachelor's degree in Health Information Management and corresponding certification (RHIT or RHIA), or Bachelor’s degree in Nursing

• MD or DO Degree from an accredited medical school

• Certified Clinical Documentation Specialist (CCDS), or current Coding Certification (CCA, CPC, CCS/CCS-P) with the equivalent of five (5) years of experience in CDI

• Five (5) years prior experience in a management role

• Three (3) years prior experience in healthcare administration, revenue cycle, health information management, clinical documentation improvement, or coding

• Two (2) years of experience in a physician leadership or advisor role

• Prior work experience using Epic

• Knowledge of diagnostic and procedural coding systems, electronic code processing

• Preferred: Current Registered Nurse (RN)

• Preferred: Master’s degree in healthcare administration, business administration, or related field.

• Preferred: Prior CDI management experience

Essential Job Functions:

In addition to the essential functions of the job listed below, employees must have on-time completion of all required education as assigned per DNV requirements, Bozeman Health policy, and other registry requirements.

• Provides leadership to CDI operations to ensure the provision of comprehensive CDI services in compliance with all regulatory agencies and organizational requirements, through continuous assessment, measurement, and improvement of departmental performance

• Ensure efficient and precise coding to support the accurate development and submission of claims for reimbursement, including timely filing requirements

• Monitor, report, and respond to key performance indicators (KPIs), i.e. accounts receivable days, candidate for billing, denials, CC/MCC capture rates, query and response rates, etc.

• Develop reports/dashboards to summarize CDI trends to the applicable committees, work groups, and department leaders

• Collaborates with the system director to ensure a departmental approach to long-range strategic operational planning, care and service design, and development of organizational policies, which reflect the mission of the organization and best practices, and ensure the provision of comprehensive departmental services in compliance with all regulatory agencies and healthcare system requirements

• Publishes educational material based on latest updates in workflows, regulations, industry guidelines, or clinician requested topics

• Demonstrates responsible management of all CDI resources, including assessment of staffing models for efficient allocation of resources

• Demonstrates clinical/technical and managerial competency; ensures staff professional needs are met

• Assesses current staffing model to determine if CDI functions are resourced appropriately

• Leads, teaches, inspires, helps and consistently demonstrates hospital healthcare system standards

• Provides ongoing education and engagement for hospital medical staff, nursing and ancillary personnel related to coding/clinical documentation improvement, compliance, utilization management, and quality issues.

• Serve as physician liaison and advisor to HIM/CDI, sharing expertise regarding improvements in documentation and workflows.

• Support and assist CDI staff in real time interventions with concurrent query education needs with the medical staff for clear, concise, and compliant documentation in order to support coding/DRG assignment.

• Conduct and document reviews and for cost and length of stay (LOS) outliers as referred. Conduct medical necessity reviews and referred denials/appeals.

Knowledge, Skills and Abilities

• Strong leadership managerial skills; ability to plan, delegate, monitor and improve work performance

• Demonstrates sound judgement, patience, and maintains a professional demeanor at all times

• Ability to escalate issues to director and provide possible issue resolution

• Ability to work in a fast-paced environment

• Strong interpersonal, verbal, and written communication skills

• Creativity, problem analysis, and decision making

• Exercises tact, discretion, sensitivity, and maintains confidentiality

• Detail oriented, organizational skills, and the ability to prioritize

• Standard office equipment and computer applications; MS Office, EMR, internet applications etc.

Schedule Requirements

• This role requires regular and sustained attendance.

• The position may necessitate working beyond a standard 40-hour workweek, including weekends and after-hours shifts.

• On-call work may be required to respond promptly to organizational, patient, or employee needs.

Physical Requirements

Lifting (Rarely – 30 pounds): Exerting force occasionally and/or using a negligible amount of force to lift, carry, push, pull, or otherwise move objects or people.Sit (Continuously): Maintaining a sitting posture for extended periods may include adjusting body position to prevent discomfort or strain.Stand (Occasionally): Maintaining a standing posture for extended periods may include adjusting body position to prevent discomfort or strain.Walk (Occasionally): Walking and moving around within the work area requires good balance and coordination.Climb (Rarely): Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like using feet and legs; may also use hands and arms.Twist/Bend/Stoop/Kneel (Occasionally): Twisting, bending, stooping, and kneeling require flexibility and a wide range of motion in the spine and joints.Reach Above Shoulder Level (Occasionally): Lifting, carrying, pushing, or pulling objects as necessary above the shoulder, requiring strength and stability.Push/Pull (Occasionally): Using the upper extremities to press or exert force against something with steady force to thrust forward, downward, or outward.Fine-Finger Movements (Continuously): Picking, pinching, typing, or otherwise working primarily with fingers rather than using the whole hand as in handling.Vision (Continuously): Close visual acuity to prepare and analyze data and figures and to read computer screens, printed materials, and handwritten materials.Cognitive Skills (Continuously): Learn new tasks, remember processes, maintain focus, complete tasks independently, and make timely decisions in the context of a workflow.Exposures (Rarely): Bloodborne pathogens, such as blood, bodily fluids, or tissues. Radiation in settings where medical imaging procedures are performed. Various chemicals and medications are used in healthcare settings. Job tasks may involve handling cleaning products, disinfectants, and other substances. Infectious diseases due to contact with patients in areas that may have contagious illnesses. *Frequency Key: Continuously (100% - 67% of the time), Repeatedly (66% - 33% of the time), Occasionally (32% - 4% of the time), Rarely (3% - 1% of the time), Never (0%).

The above statements are intended to describe the general nature and level of work being performed by people assigned to the job classification. They are not to be construed as a contract of any type nor an exhaustive list of all job duties performed by the personnel so classified.

77211350 Compliance